The overall decline in the use of tobacco and excessive alcohol consumption has contributed to reductions in certain cancers involving the head and neck. Nonetheless, head and neck cancer is the sixth most common malignancy worldwide, resulting in more than 600,000 deaths each year worldwide. Moreover, notes Maie St. John, MD, PhD, the Thomas C. Calcaterra Chair of the UCLA Department of Head and Neck Surgery, the recent rise of vaping and e-cigarette use, particularly among younger people, warrants considerable concern. “We haven’t had a long enough period of time to fully understand to what extent those agents, which can cause mutations in the oral cavity or in the lung, are going to lead to potential cancers down the line,” Dr. St. John says.
Head and neck cancer researchers currently are grappling with two emerging epidemics. One involves what’s known as young tongue cancer. “We are seeing a growing number of patients under the age of 45 who develop a lesion on their tongue that initially is thought to be a canker sore but continues to grow,” Dr. St. John explains. “These cancers can be very aggressive, and they are not linked to tobacco or alcohol use.” UCLA researchers are seeking to understand both the risk factors and the underlying genetics for this type of cancer, she says.
Dr. St. John notes that there also is a sharp increase in human papilloma virus (HPV)-positive cancers. HPV has long been associated with cervical cancer risk, but now HPV-positive cancers in the throat, base of tongue and tonsil areas are on the rise. UCLA is part of a major study to understand the risk factors for these cancers, as well as potential strategies for prevention, early detection and effective treatment.
For all head and neck cancers, Dr. St. John and her UCLA colleagues are moving toward so-called precision surgery — the ability to more clearly visualize cancer cells in the operating room so that surgeons can cut around them and preserve as much healthy tissue as possible, allowing patients to have both longer lives and better function. Similarly, UCLA’s head and neck cancer researchers are closely collaborating with researchers in other departments at UCLA to take advantage of advances in genomics and related fields to move toward drug treatments that are specific to the mutations driving individual tumors — so-called precision medicine.
UCLA has also been a leader in studying the use of immunotherapy for the treatment of head and neck cancers, including immune checkpoint inhibitor therapy — an approach, successful in melanoma and other cancers, which uses drugs to block specific proteins that act as “brakes” on the immune system, thereby unleashing a more robust immune response against the cancer. UCLA’s head and neck cancer researchers are also collaborating with bioengineering colleagues to develop new ways to deliver both immunotherapy and other treatments nonsystemically, to ensure that the cancer treatment doesn’t affect the heart, liver or other vital organs.
Dr. St. John notes that just as important as research into better treatments for head and neck cancers is her department’s emphasis on providing patient-centered care, which has fueled the development of a multidisciplinary clinic that enables patients to visit all of the experts they need to see in a single morning or afternoon within the same facility. “As we continue to unravel the mysteries of these cancers and push the envelope forward, we’re going to shape a brighter future for patients with this disease,” Dr. St. John says. “We want to make sure that translates into care that is not just cutting-edge, but also compassionate and optimal.”